Comparison of single-stage and two-stage bilateral video-assisted thoracic surgery

Abstract

Objective Single-stage sequential bilateral video-assisted thoracoscopic surgery (VATS) is a controversial procedure. In the present study, we retrospectively compared the outcomes of single-stage and two-stage VATS. Methods This study involved patients who underwent single-stage sequential bilateral VATS (SS-VATS group) or two-stage VATS at a 3-month interval (TS-VATS group) for treatment of non-small cell lung cancer from 2010 to 2018. The major outcome was the comparison of intraoperative changes. Results The inspiratory peak pressure was higher, the incidences of intraoperative hypoxia and unstable hemodynamics were higher, the surgical time was longer, and the durations of the intensive care unit stay and postoperative hospitalization were longer in the SS-VATS group than in the TS-VATS group. However, the chest tube duration, incidence of postoperative mechanical ventilation, and clinical complications were not different between the two groups. Conclusions Compared with two-stage VATS, single-stage sequential bilateral VATS can be performed for successful treatment of bilateral pulmonary lesions with a shorter total time and higher cost-effectiveness in terms of anesthesia and hospitalization but with a higher incidence of intraoperative adverse effects and a longer hospital stay.

Robot‐assisted resection of multiple lung nodules through combination of intercostal incisions and a subxiphoid incision as a utility port

“…However, they were performed through the intercostal space ports, and to our knowledge, one‐stage bilateral lobectomy through subxiphoid port has not been reported. Advantage of performing one‐stage bilateral approach includes reducing the cost of hospital stay and treatment, avoiding second time painful procedure of anaesthesia and surgery, and reducing patient's anxiety although it may result in higher incidence of intraoperative adverse effects 20 …”

“…[16][17][18][19] Single-stage bilateral thoracic surgery has recently been advocated for the treatment of multiple pulmonary nodules with advantage of reducing the cost of hospital stay as well as avoidance of second time painful operative procedures. [20][21][22] In this regard, studies have shown that there was no significant difference in the outcomes, including postoperative complications and duration of chest drains, between one-stage and two-stage bilateral thoracic surgery for the patients with multiple primary nodules or metastatic lung cancer. 20,22,23 The enlarged single incision of subxiphoid port provides an acceptable angle for tackling all the hilar structures.…”

Effects of Non-intubated Video-Assisted Thoracic Surgery on Patients With Pulmonary Dysfunction

“…Since long-term spontaneous breathing during NIVATS may lead to hypoxia and hypercapnia. Previous unilateral lobectomy and contralateral wedge resection (23), as well as lung volume reduction surgery in patients with COPD (7,(24)(25)(26), these patients with severe pulmonary dysfunction, are more suitable for NIVATS.…”

“…Licker showed that an FEV 1 <60% was associated with an increase in respiratory complications ( 27 ). Awake non-resectional LVRS has been proved feasible and safe for patients with severe pulmonary dysfunction with a faster recovery ( 11 , 28 , 29 ) and satisfactory 6-month outcome ( 23 ), and with less prolonged air leak ( 30 ). As for patients with moderate pulmonary dysfunction, NIVATS can also be proved to work ( 10 ).…”

The feasibility and safety of simultaneous bilateral video-assisted thoracic surgery for the treatment of bilateral pulmonary lesions

“…Another study ( 14 ) compared the intraoperative changes between simultaneous and staged pulmonary surgery using VATS and found that unstable hemodynamics caused by longer operation durations and a change in position increased the use of vasoactive drugs and may also have increased blood loss. However, the study found no difference between the two types of surgery in terms of postoperative complications, thereby demonstrating the safety and feasibility of simultaneous bilateral pulmonary surgery with rigorous intraoperative management and suggesting that simultaneous surgery can be considered for patients with bilateral pulmonary lesions after strict preoperative evaluation.…”